Comparison between chemoradiation protocol intended for organ preservationand conventional surgery for clinical T1-T2 esophageal carcinoma

Purpose: This retrospective study was designed to compare treatment results of the chemoradiation protocol with conventional surgery for thoracic T1-T 2 esophageal squamous cell carcinoma. Methods and Materials: Sixty-six patients with esophageal carcinoma, clinic ally diagnosed as T1 (tumor invading lamina propria or submucosa) or T2 (tu mor invading muscularis propria) were treated for 12 consecutive years, fro m July 1986 to January 1998. The conventional surgery group included 30 pat ients who underwent esophagectomy with regional lymph node dissection. Twen ty-one of them received postoperative radiotherapy. Thirty-six patients wer e assigned to the chemoradiation protocol, consisting of neoadjuvant chemor adiotherapy (44 Gy; CDDP: 60 mg/m(2), day 1, bolus; 5-FU: 400 mg/m(2), day 1-4, continuous), followed by either definitive radiotherapy with high-dose -rate intraluminal brachytherapy (total 70 Gy) for responders or surgery fo r nonresponders as in the conventional surgery group. Surgical candidates i n both groups received intraoperative radiotherapy for abdominal lymphatics since 1991. Results: In the protocol group, 4 patients underwent radical surgery after neoadjuvant chemoradiotherapy, and the remaining 32 underwent definitive ch emoradiotherapy. Local control rates at 1 and 3 years were 85% and 70% in t he T1/protocol group versus 91% and 80% in the T1/surgery group, and 83% an d 83% in the T2/protocol group versus 94% and 80% in the T2/surgery group, respectively. There was no statistical significance. Overall 1- and 3-year survival rates were 100% and 83% in the T1/protocol group versus 82% and 72 % in the T1/surgery group (p = 0.36), and 100% and 51% in the T2/protocol g roup, versus 95% and 68% in the T2/surgery group (p = 0.61), respectively. There was no treatment-related mortality in either group. The rates of esop hageal conservation were 92% in the T1/protocol group and 58% in the T2/pro tocol group. Conclusion: The chemoradiation protocol can result in comparable survival w ith conventional surgery for patients with T1-T2 esophageal carcinoma. A ra ndomized trial between definitive chemoradiotherapy and surgery is required . (C) 1999 Elsevier Science Inc.